The contraction cycle and the overall pattern of contractions are also described in terms of frequency, duration, and intensity. The decrement is the period of decreasing intensity as the uterus relaxes. ![]() The peak, or acme, is the period during which the contraction is most intense. The increment occurs as the contraction begins in the fundus and spreads throughout the uterus. Labor contractions are intermittent rather than sustained, allowing relaxation of the uterine muscle and resumption of blood flow to and from the placenta to permit gas, nutrient, and waste exchange for the fetus.Įach contraction consists of three phases ( Figure 16-1). Anxiety and excessive stress can diminish them. Walking or other activity may stimulate existing labor contractions. The mother cannot cause labor to start or stop by conscious effort. Uterine contractions are not under conscious control, as are skeletal muscles. Coordinated labor contractions begin in the uterine fundus and spread downward toward the cervix to propel the fetus through the pelvis. As the woman approaches full term, contractions become organized and gradually assume a regular pattern of increasing frequency, duration, and intensity during labor. The uterus can contract and relax in a coordinated way, as can other smooth muscles such as the heart. Normal labor contractions are coordinated, involuntary, and intermittent. Significant changes during labor occur in the woman’s cardiovascular, respiratory, gastrointestinal, urinary, and hematopoietic systems as well as in her reproductive system. These effects are most striking in the maternal reproductive system and in relation to fetal and neonatal oxygenation. Labor and birth affect the physiologic systems of both the pregnant woman and her fetus. In more advanced labor, both partners often welcome the presence of a competent, caring nurse of either sex. If they want privacy, the nurse should intervene only as needed to assess the woman and fetus. The best approach for both male and female nurses is to maintain professional conduct and take cues from the couple. He often wonders how a woman’s male partner will accept him as a care provider. Although he may have cared for other female clients, his care has not been this focused on the reproductive system. The male nurse often finds this aspect of intrapartum care most anxiety provoking. They may feel that they are intruding on a private time. The intimate nature of intrapartum care and its sexual overtones also make some nurses uncomfortable. Some days are busy from the start, whereas others are uncannily quiet, only to erupt in adrenaline-charged action with no warning. Some nurses find the uncertain nature of intrapartum care troubling, whereas others find it exciting. Some occurrences simply are not easily predicted or explained. Labor is a natural process that follows its own timetable. They must be careful not to convey negative attitudes to the laboring woman and her partner. Nurses also may be anxious because of their own difficult experiences during pregnancy or birth. Nursing skills needed by the intrapartum nurse are basic: observation, critical thinking, problem solving, therapeutic communication, comfort promotion, empathy, and common sense. The nurse who has never given birth may feel inadequate to care for laboring women, although she or he rarely feels it necessary to have a fracture to care for someone with that problem. Helping the woman manage the pain of birth is a crucial part of nursing care. Yet pain is an expected part of labor and cannot be eliminated. Working with people in pain is difficult, and most nurses feel compelled to relieve pain promptly. Family roles and relationships are forever altered by this event.Ĭommon issues face new nurses and nursing students when caring for families during birth. The birth of a baby is more than a physical event it has deep personal and social significance for the family. Apply the nursing process to care of the woman and her family during the intrapartum period.Ĭare of the woman and her family during labor and birth is a rewarding field of nursing.Apply the nursing process to care of the woman experiencing false labor.Relate therapeutic communication skills to care of the intrapartum family.Identify nursing priorities when assisting the woman to give birth under emergency circumstances. ![]() Describe admission and continuing intrapartum nursing assessments.Compare the stages of labor and the phases within the first stage. ![]()
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